Neoligaments JewelACL Consignes D'utilisation page 5

tunnel at its intercondylar exit with an ACL tunnel
rasp.
11. With the knee flexed at 90º use an appropriate
tibial guide to identify the intra-articular tibial
attachment (Figure 3). This should be located
slightly medial and slightly anterior to the centre
of attachment of the natural ACL. It should not
interfere with the anterior attachment of the medial
meniscus and should avoid damaging the articular
cartilage. Avoid placing too anteriorly as this can
lead to impingement of the ligament on the roof of
the notch at full extension. Leave the tibial footprint
of the ACL intact.
12. Use a tibial guide to drill a guidewire into the tibia.
Ensure an adequate tunnel length is produced to
accommodate an interference screw.
13. Remove the tibial guide, leaving the guidewire.
Over-drill with a cannulated bone tunnel drill
matched to the overall graft size or make a tunnel
1 mm smaller than the graft and expand to the
desired size using serial dilators. Where possible,
chamfer the edges of the intercondylar exit with an
ACL tunnel rasp.
14. Pull the assembly into the tunnels following the
instructions for the ECLU. Ensure the button is
securely seated on the femoral cortex.
15. With the knee in full extension, separate and
tension the two strands of the graft. Introduce the
screw centrally between the strands in the bone
tunnel. Ensure the strands of the graft do not twist
and end up on the same side of the screw.
16. Trim excess hamstring graft from the tibial tunnel
entrance and tie the strands of the JewelACL over
the back of the screw with a reef knot to provide
additional fixation and prevent the graft slipping
past the screw (Figure 4).
17. Where possible attach the ACL remnants to the
graft using appropriate sutures.
18. Cycle the knee through a full range of motion while
examining the graft arthroscopically to ensure that
it has been placed isometrically and allows a full
range of motion with no graft impingement.
19. Check security of the knot before trimming any
excess strands of the JewelACL. Cut each strand
with scissors at right angles to its length, to
minimize the generation of loose fibres. Any loose
fibres created when trimming to length must be
carefully removed from the incision site.
20. Bury the knot in soft tissue.
Trademarks
TransFix is a registered trademark of Arthrex, Inc.
EndoButton and RCI Screw are registered trademarks
of Smith & Nephew, Inc.